HomeMy WebLinkAboutpitkin.eh.264326402011 (1975)_VOIDED 1993, STRUCTURE TORN DOWN'PERMIT NUMBER
Owner /VI u X
79f �*, PITKIN COUNTY HEALTH DEPARTMENT
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RECEIPT NUMBER g-7,
Phone #
Owner's Mailing Address
Contractor 1-3-4 Co A/ S % •• �C3 . Phone # 92 7- 3 9 Z
Address 00 X 1,5 3 LTA C -a 1- O ,116 Z
Systems Contractor's Name U S E YU TE R p R\ SE S
Address
Legal Description_ Lo / R 2 S / %)?W oUD 7
Lot Size
412 0, /K :3- d r Type of Building by Use
Number of Bedrooms
FType of
Type of
Proximal
Individual Sewage Disposal
Type of Water Supply w O o D
System NK
Soil or Soil Classification 1,QA 1 '%"Q CIZ1.4 y
Location of Bedrock A/,9 -r �DETERA IN , i O
_Proximal Location of Ground Water Table Al rc—TER.M /MC: D 7
Owner's Signature HCl G� Dated/��
PLOT PLAN:
Percolation Test Data MOM 40 mow Minut per inch t
Minimum Recomended Absorption System Size /46404_
Minjw
y'llecRmmended Tank Size Vre.
_14
7Perp kation valid one year from DApplication to become�eind in on y
after lower portion is completed and signed by the Sanitarian. RETAIN THIS FOAT HE
CONSTRUCITON 4ITE.
Date{� f Sanitarian
(_ awing of system on back)
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PERCOLATION TEST FIELD SHEET
NAME OF OWNER PHONE
ADDRESS
LEGAL DESCRIPTION OF PROPERTY_
At least two (2) test holes per system must be run. They should be in the
area of the proposed leaching system and dug to the depth of the proposed system,
generally 2.5 to 3 feet deep.
The holes are to be soaked for a 24 hour period prior to running the test.
Test Hole I
Teat. Hnl a TT
Reading
Drop
Time
�ReadinEDrop
Time
7 Y
4
X
L yq
i
I
PERCOLATION TEST RESULTS:
Hole I Q Q Minutes per inch Hole II �`7 Minutes per inch ' 0
Average percolation rate: 440 Minutes per inch T
Comments on soil and/or site:
Name of person running test:,o Phone:
AAddress: Signature:
t
PERCOLA`T'ION TEST FIELD SHEET
NAME OF OWNER �f%f'�_ PHONE
ADDRESS
LEGALDESCRIPTIONOF PROPERTY
S/'�9, e W0o D
At least two (2) test holes per system must be run. They should be in the
area of the proposed leaching system and dug to the depth of the proposed system,
generally 2.5 to 3 feet deep.
The holes are to be soaked for a 24 hour period prior to running the test.
Reading 77r o o Time me`'""vK i�
Hole I
PERCOLATION TEST RESULTS:
Minutes per inchb Hole II
ss�
0
4'5
70
Minutes per inch /
Average percolation :rate: Minutes Der inch
Comments on soil -and/or site
Cx
add, r
Nacre of person running test:
Address:
-1
1-C"V"'V4fPhone
Signature:
---
1
20
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J
o
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3ZA
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Hole I
PERCOLATION TEST RESULTS:
Minutes per inchb Hole II
ss�
0
4'5
70
Minutes per inch /
Average percolation :rate: Minutes Der inch
Comments on soil -and/or site
Cx
add, r
Nacre of person running test:
Address:
-1
1-C"V"'V4fPhone
Signature:
---
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